CHEST DRAINAGE PRODUCT TRAINING COURSE Richard Å vec, M.D.

2. CHEST DRAINAGE PRODUCT TRAINING COURSE Richard Švec, M.D.

3. Training overview • Anatomy, physiology and mechanics of breathing • Pneumothorax, Haemothorax • Principles of underwater seal chest drainage • From the bottle system to CDU • Chest drainage products (features and benefits)

4. Anatomy of the Chest Cavity Trachea Left Lung Right Lung Mediastinum Diaphragm Pericardium Intrapleural space Intrapleural space

5. Intrapleural Space Visceral pleura Chest wall Lung Parietal pleura Zoom Intrapleural space

6. Principles of Respiration The pressure of a given quantity of gas is inversely proportional to its volume.

7. Principles of Respiration Increasing volume causes a decrease in pressure, which causes air to rush in as the pressures reach equilibrium.

8. Principles of Respiration Decreasing volume causes an increase in pressure, which causes air to be expelled as pressures reach equilibrium.

9. The Lungs • Passive organ (can not make any • movements by itself) • Needs to be expanded to work • Expansion of the lungs is achieved by: • Negative intrapleural pressure • Lung surface tension • Air inlet/outlet into/from lungs is • achieved by: • Increase/Decrease of the volume of the • chest cavity (Boyle´s law)

10. Mechanics of Respiration Inspiration process Air in Contraction of diaphragm and intercostal muscles Increase of the negative intrapleural presure Expansion of the lungs Air inlet to lungs

11. Mechanics of Respiration Expiration process Air out Relaxation of diaphragm and intercostal muscles Decrease of the negative intrapleural presure Relaxation of the lungs Air outlet from lungs

12. Abnormal Conditions • Violation of the closed system of the thoracic cavity • Loss of the negative intrapleural pressure • Accumulation of air in the intrapleural space • Accumulation of fluid in the intrapleural space ! ! PARTIAL OR FULL LUNG COLLAPSE DIMINISHED RESPIRATION TREATMENT NEEDED

13. Terminology • Pneumothorax • accumulation of air in the pleural space • Haemothorax • accumulation of blood in the pleural space • Haemopneumothorax • accumulation of air and blood in the pleural space • Fluidothorax • accumulation of any other fluid (matter) in pleural space • Haemomediastinum • accumulation of blood in mediastinum

14. Pneumothorax • External pneumothorax • Opening in the chest wall. Air directly enters and • leaves the intrapleural space - open communication. • Loss of negative intrapleural pressure. 0 • Internal pneumothorax • Opening in the lung. Air enters and leaves intrapleural • space through lung. Loss of negative intrapleural • pressure. 0 • Tension pneumothorax (Valve pneumothorax) • Opening in the lung or chest wall. Air enters the • intrapleural space but can not leave out. Building of • possitive intrapleural presure. (+) !!!!!!

15. Pneumothorax Opening in chest wall Trauma, operation AIR Opening in the chest wall Open communication Loss of the negative intrapleural pressure Collapse of the lungs

16. Tension Pneumothorax One way (valve) Opening in lung Trauma Opening in the lung AIR Loss of the negative intrapleural pressure Collapse of the lungs Risk of building of positive intrapleural presure !! Risk of mediastinal shift !!!

17. Pneumothorax, Haemothorax Objectives of treatment • Removal of air • Removal of fluid • Re-building of negative intrapleural pressure Lung re-expansion

18. Pneumothorax, Haemothorax Method of treatment UNDERWATER SEAL THORACIC DRAINAGE

19. Underwater Seal Chest drainage • Provides means for air and fluid to escape the chest cavity • Prevents air from re-entering the pleural space • Re-establishes intrapleural negative pressure • Re-expands the lungs To the drainage system

20. One bottle system Air out From patient For small pneumothorax use only ! Risk of progressive resis- tance building by haemothorax. No control of the situation in the chest cavity. Water seal

21. Two bottle system From patient Separation of water seal and collection in 2 bottles elliminates the risk of progressive resistance building. No active suction co- nection recommended. Limited information about the situation in the chest cavity Air out Collection bottle Water seal

22. Three bottle system Active suction From patient Suction control bottle Collection bottle Water seal

23. Three bottle system • Separated collection, underwater seal and suction • control bottle • No risk of progressive resistance building • Exact active suction control • Limited information about the situation inside the • chest cavity

24. Four bottle system From patient Active suction Patient assesment bottle Suction control bottle Collection bottle Water seal bottle

25. Four bottle system From patient Active suction Patient assesment bottle Suction control bottle Collection bottle Water seal bottle

26. Four bottle system • Separated collection, underwater seal, suction • control and patient assesment bottles • No risk of progressive resistance building • Exact active suction control • Exact information about the situation inside • the chest cavity

27. Complicated to • assemble and • connect to patient • Problem to • transport • Made from vulne- • rable material • Difficult to monitor IMPROVEMENT NEEDED Bottle systems

28. From bottles to CDUs

29. Patient 3Ch.CDU system Active suction Suction control chamber Collection chamber Underwater seal chamber

30. TYCO Healthcare offers complete line of the chest drainage units

31. THORA SEAL I • Analogy of the one • bottle concept • For pneumothorax • only • Compact, easy to use • Disposable, break • resistant • for gravity drainage • only • Self contained floor • stand • Ready to use

32. THORA SEAL II • Analogy of the two bottle • concept • Separated underwater • seal chamber and 2,6 • litre collection chamber • Easy to read Hi/Low volume • graduations (write on) • Integrated floor stand • Strand hanger • Clear PVC connection tubes • with anti kink device

33. THORA SEAL III • Analogy of the 3 bottle • concept • Compact, break resistant • Removable/Replacable • collection chamber with: • - Hi/Low volume graduations • - White, write-on background • Unique baffle system prevents • fluids from spilling and mixing

34. THORA SEAL III • Automatic possitive pressure • relief valve • Build-in hanger, floor stand • and tube anti-kink device • Muffler in suction control • Self-sealing Kraton patient tube

35. Aqua Seal • 3 bottle system concept • Compact, break resistant • Easy to install and use • Collection chamber: • - Paediatric and adult graduations • - White, write on background • - Kraton self-sealing patient tube • - Croppable connector

36. Aqua Seal • Underwater Seal Chamber: • - blue coloured water level • - Patient assessment graduations • - Syrringe for easy filling in • - Automatic possitive pressure • releif valve • - Manual negative pressure relief • valve • - Water seal access port

37. Aqua Seal • Suction control chamber: • - flow control valve on suction • port • - Suction control bypass adapter • - Wide opening for easy filling in • Other: • - Wide 90 degree rot. footstand • - Steel hangers • - Integrated handle • - Setup instructions on unit • - Double CSR warp

38. Aqua Seal

39. Aqua Seal

40. Sentinel Seal • Modified four bottle concept • Exclusive „dry“ suction control • regulator • Quiet operation • Exclusive patient assesment • chamber with blue coloured • water level • Automatic possitive pressure • releif valve • Filtered manual negative pressure • relief valve • Easy to setup and use • Crystal clear, compact

41. Double Seal Four bottle system concept Collection chamber - 3 column chamber - Hi/low graduation for paediatric and adult use - White, write on background - self sealing collection tube Underwater Seal chamber - blue coloured water level - patient and/or system air leak control

42. Double Seal Suction control chamber - Bubbling suction controler - blue coloured water level - automatic possitive pressure relief valve Patient assessment chamber - actual negative pressure readout - continuous monitoring of lung reexpansion process - possitive pressure relief - Automatic negative pressure relief

43. Patient Assessment - what is the CDU telling me Tidaling* Bubbling** Large pneumothorax or system leak - lung still not re-expanded Check for changes Lung reexpansion (slide tidaling can be observed). Check the collection tube for kinking Connection or system leak Pinch off the catheter. If the same check all connections. Stiff lung desease or patient after pneumonectomy Yes Yes No No No Yes Yes No

44. Thoracic catheters For open chest application (peroperative) • Made from thermosensitive PVC or clear silicone • Sentinel Line and Eye for X-ray possition verification • Smooth finish on tip and eyes • Integral bubble connector for easy connection • Rigid pack container

45. Trocar catheters For closed chest drainage Thoracic catheter intimately seated on aluminium trocar rod Trocar caries the catheter with it as it penetrates the chest wall and enters pleural cavity Colour coded trocars for easy indentifiaction

46. Safety Shield Trocar catheters NEW !!! Argyle • ....a safety trocar thoracic catheter which: • Minimizes the risk of inadverent lung puncture • Provides safe, quick access to the pleural space

47. Thoracentesis Exclusive Turkel Safety thoracic punture system Minimal risk of lung punture and pneuomothorax Safety canula - withdraws into the shaft during chest wall penetration Automaticaly extends when entering pleural space Safety color change indicator confirmes the position

48. Thoracentesis Pateneted safety valve allows air and fluid to leave the chest cavity, prevents atmospheric air to enter. Soft and flexible polyurethane radiopaque catheter with 1 cm graduations and multiple side holes